Perri Paolo, Sena Giuseppe, Piro Paolo, De Bartolo Tommaso, Galassi Stefania, Costa Davide, Serra Raffaele
Department of Vascular and Endovascular Surgery, Annunziata Hospital, 1 Via Migliori, 87100 Cosenza, Italy.
Department of Vascular Surgery, "Pugliese-Ciaccio" Hospital, 88100 Catanzaro, Italy.
Gels. 2024 May 2;10(5):312. doi: 10.3390/gels10050312.
This review focuses on the use of conventional gel or coil and "new" generation hydrogel used as an embolic agent in endovascular applications. In general, embolic agents have deep or multidistrict vascular penetration properties as they ensure complete occlusion of vessels by exploiting the patient's coagulation system, which recognises them as substances foreign to the body, thus triggering the coagulation cascade. This is why they are widely used in the treatment of endovascular corrections (EV repair), arteriovenous malformations (AVM), endoleaks (E), visceral aneurysms or pseudo-aneurysms, and embolisation of pre-surgical or post-surgical (iatrogenic) lesions. Conventional gels such as Onyx or coils are now commercially available, both of which are frequently used in endovascular interventional procedures, as they are minimally invasive and have numerous advantages over conventional open repair (OR) surgery. Recently, these agents have been modified and optimised to develop new embolic substances in the form of hydrogels based on alginate, chitosan, fibroin and other polymers to ensure embolisation through phase transition phenomena. The main aim of this work was to expand on the data already known in the literature concerning the application of these devices in the endovascular field, focusing on the advantages, disadvantages and safety profiles of conventional and innovative embolic agents and also through some clinical cases reported. The clinical case series concerns the correction and exclusion of endoleak type I or type II appeared after an endovascular procedure of exclusion of aneurysmal abdominal aortic (EVAR) with a coil (coil penumbra released by a LANTERN microcatheter), the exclusion of renal arterial malformation (MAV) with a coil (penumbra coil released by a LANTERN microcatheter) and the correction of endoleak through the application of Onyx 18 in the arteries where sealing by the endoprosthesis was not guaranteed.
本综述聚焦于传统凝胶或线圈以及新一代水凝胶在血管内应用中作为栓塞剂的使用情况。一般来说，栓塞剂具有深入或多区域的血管穿透特性，因为它们通过利用患者的凝血系统来确保血管的完全闭塞，凝血系统将它们识别为身体外来物质，从而触发凝血级联反应。这就是为什么它们被广泛用于血管内矫正（EV修复）、动静脉畸形（AVM）、内漏（E）、内脏动脉瘤或假性动脉瘤的治疗，以及手术前或手术后（医源性）病变的栓塞。诸如Onyx等传统凝胶或线圈目前已商业化，二者均常用于血管内介入手术，因为它们微创且相较于传统开放修复（OR）手术具有诸多优势。最近，这些栓塞剂已被改性和优化，以开发基于藻酸盐、壳聚糖、丝素蛋白和其他聚合物的水凝胶形式的新型栓塞物质，以确保通过相变现象实现栓塞。这项工作的主要目的是扩展文献中已有的关于这些装置在血管内领域应用的数据，重点关注传统和创新栓塞剂的优缺点及安全性，还通过一些报告的临床病例进行阐述。该临床病例系列涉及使用线圈（由LANTERN微导管释放的线圈半影）对腹主动脉瘤血管内排除术（EVAR）后出现的I型或II型内漏进行矫正和排除，使用线圈（由LANTERN微导管释放的半影线圈）对肾动脉畸形（MAV）进行排除，以及在无法保证内支架密封的动脉中应用Onyx 18来矫正内漏。
